“There’s value for clinicians who want to see how they are doing compared with their peers.”


healthier to avoid those costly things on the back end,” said Scott Albosta, BCB- STX vice president of network perfor- mance management. At the same time, “we know those pa- tients are getting quality care,” he said.


“We believe rewarding physicians for ex- cellence in chronic condition care influ- ences provider behavior, which increases the quality of care delivered. The more physicians who are recognized, the bet- ter the chance our members are going to go to a physician practicing with a high degree of expertise in chronic condition care management.”


More information about the program is available on TMA’s website at www .texmed.org/BTE.aspx. “These are measures that have been


around a long time, and these are things physicians are already doing or should be doing,” said Keller family physician and Council on Health Care Quality member Gregory M. Fuller, MD. The pro- gram provides “a way to quantify that you are providing quality care. If you qualify, you get recognition for providing that quality care. And you can earn addi- tional monies, and that’s very important for primary care practices.” So far, BTE has been responsive to physician input on quality measures, an- other key factor in the council’s decision to support the program, Dr. Ehrlich add- ed. And because the program involves a certification, rather than a ranking, “100 percent of physicians can qualify.” To test the program and its potential benefits, TMA and the Harris County Medical Society (HCMS) began a Dia- betes Reporting Pilot Program in 2011 with 48 TMA member physicians in 17 practices in family medicine, endocri- nology, and internal medicine. They saw potential earnings of $3,950 on average and $189,363 as a group for the initial submission of their quality data to both the diabetes and cardiac programs. Dr. Ehrlich says her participation in


the program has been worthwhile: BCB- STX pays $150 per covered diabetic


60 TEXAS MEDICINE September 2013


patient per year; Aetna pays $100. Her group sees between 25 and 60 diabetic patients per physician per year in those two plans, which means anywhere from $2,500 to $9,000 in annual incentive payments for each doctor. For the most part, the bonuses com- pensate Dr. Ehrlich’s practice for the work it was already doing. “But one ben- efit we have seen is an improvement in our office process to make sure that we are able to identify gaps in care, includ- ing everything from patient noncompli- ance to finding patients who have not yet had their pneumonia vaccine and the like.”


A win-win Payers also are reaping rewards, as qual- ity care turns into cost-effective care. For BCBSTX, the bonuses in the dia-


betic program have translated to $1,000 more in annual per-patient savings, when compared with diabetics treated by non-BTE-recognized doctors. Those savings helped fund more than $3 mil- lion in cash payouts to physicians since the Blues plan adopted BTE. “If we look at cost of care for those physicians recognized for BTE, we see a higher spend in professional services and a lower spend in hospital admis- sions and emergency visits, and it flip- flops for non-BTE-recognized physicians. And we want to incentivize physicians to pay attention up front and keep patients


The savings generated by BTE are catching employers’ eyes, too, who also are looking for high-quality, cost-effec- tive coverage options for their workers. That’s just one reason payers like BCB- STX are enhancing and expanding their BTE programs, matched by what ap- pears to be a growing physician interest. The Texas Blues, for example, in-


creased the incentive payments in the diabetes program from $100 to $150. Network physicians who either earn BTE recognition for the first time or renew the two-year designation in the diabetic program can earn another $500 bonus. It also extends to the new asthma pro- gram to encourage physicians to join. From 2009 to 2013, participation by Blues physicians in the BTE diabetes pro- gram jumped from 40 to more than 600. The cardiac care program started with 80 physicians in 2010, and that number grew to about 240 this year. Four doc- tors signed on to the asthma track. Those numbers have a lot to do with the incentives offered by a growing list of interested payers. BTE also continues to add more programs since it began in 2002.


But the mission has not changed, says Jessica DiLorenzo, program imple- mentation leader for Health Care Incen- tives Improvement Institute (HCI3), a nonprofit organization that runs Bridges to Excellence. That goal is “to provide incentives to clinicians to demonstrate high levels of patient care.” While there still is some work in- volved for physicians in reporting clini- cal data to get those bonuses, “there’s very little downside,” she said.


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68